Historia de la Preparatoria “Emiliano Zapata”

lose their jobs or after death of the principal member, and also regulates the transferability of membership between medical schemes.

(g) Savings accounts

Clause makes provision for personal medical savings accounts for

payment of health care expenses in a manner which be prescribed.

7. CHAPTER DESIGN

(a)

Clause 34 regulates the registration of multiple benefit options medical

schemes. Currently many options are registered even when they lead to a medical scheme being financially unsound. The new approach would lawfully require that these options must at all times include the prescribed minimum benefit package; be self-supporting in terms of membership and financial soundness, and be properly secured through guarantees when the Registrar is of the opinion that this is necessary.

Clause 35 prohibits the cession or attachment of benefits payable under this

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8. CHAPTER 7: FINANCIAL SOUNDNESS OF MEDICAL SCHEMES CLAUSES 36 TO 39

It is necessary that the requirements regarding financial stability extended to enforce compliance with stricter controls to ensure a financially strong industry and to avoid demise as a result of mismanagement or otherwise. It is essential that all medical schemes comply with statutory determined solvency and financial soundness requirements, failing which, remedial action is to be taken by the authorities in a pro-active manner which is consistent with legislation controlling other financial entities. In order to do so, it is also regarded necessary that detailed financial information regarding perfor- mance of benefit options are submitted to make an assessment of the situation.

This

Chapter regulates financial arrangements within medical schemes in a “ number of ways. First, medical schemes are required to, at all times, be

in a

position to meet their liabilities. Medical schemes are also required to maintain mandatory net assets which will be monitored by the Council. (c) In addition to financial soundness requirements, it is regarded essential that

the audit function and auditors should play a more constructive role in the process of reporting on financial results and calculation of contingent liabilities. Explicit provision is made in clause 37(10) for audit committees within medical schemes to assist schemes’ trustees to better manage and evaluate medical scheme’s financial performance. This is in line with corporate governance and similar legislation which controls other financial entities. Auditors are furthermore obliged in terms of clause 37(8) to report irregularities and untoward circumstances directly to the registrar while being indemnified from any action taken against them as a result thereof.

Clause 38 deals with the annual reporting of audited financial results to the

Registrar. 9. CHAPTER 8

CLAUSES 40 TO 42

This Chapter relates to requirements in relation to documents to be deposited with the the effect of the Registrar’s certificate on documents, and the right to obtain and inspect documentation.

10. CHAPTER 9 CLAUSES 43 TO 47

Chapter 9 deals with the powers of the Registrar to require additional particulars from medical schemes, to make enquiries and to require persons who are not registered under this Bill to make information available to the Registrar to establish whether this Act is contravened and to take action against perpetrators.

11. CHAPTER 10: COMPLAINTS AND APPEALS CLAUSES 48 TO 51

This Chapter deals with the lodging and settlement of complaints, disputes and appeals within medical schemes. Provision is also made for the introduction of an independent Appeal Board appointed by the Minister, with the purpose of hearing an appeal lodged by any person who is aggrieved by a decision of the Registrar or the Council.

12. CHAPTER 11: JUDICIAL MATTERS CLAUSES 52 TO 57

(b)

by the Registrar, the judicial management of a medical scheme, the winding-up of a medical scheme, information as to a compromise and the appointment of a curator. The Bill allows persons other than the Registrar to apply to the court for the judicial management or the winding-up of a medical scheme should it be in the interests of the members.

Provision is made in clause 57 for a medical scheme to be placed under curatorship in terms of the Institutions (Investment of Funds) Act, 1984 (Act No 39 of 2984). This allow for the replacement of the board of trustees where there is a need to rectify matters of concern, or to enable a medical scheme to restore its financial soundness.

13. CHAPTER 12 GENERAL CLAUSES 58 TO 71

This Chapter deals with general provisions in the Bill and include:

Administration of a medical schemes by an intermediary (Clause 59)

Currently there are instances of sub-optimal administration of certain medical schemes. The Bill requires that administrators be accredited by the Council on the basis of objective criteria. These objective criteria will be defined in the Regulations and will ensure that contractual relationships between medical schemes and administrators are optimal and are in the interests of members at all times. This principle is in line with administration of pension funds.

Preservation of secrecy (Clause 61)

Clause 61 requires that confidentiality is maintained in specified instances by the Council, its employees and members of the Appeal Board with regard to information obtained in terms of investigations in instances where such confidentiality serves the public interest.

Undesirable business practices (Clause 62)

Currently, certain medical schemes, their associates and contracting parties engage in a number of practices that may not be in the interest of members. In addition, these practices change constantly. There is therefore a need to define

some being engaged in by medical schemes and as

“undesirable business practices” and to enable the Registrar and the Council to put a stop to such practices. In order to guarantee sufficient procedural safeguards to the affected parties, provision is made that a particular will be declared undesirable by the Registrar only with the of the Council and the Minister. This is consistent with provisions in insurance legislation.

and penalties (Clause 67)

The Bill propose to effective administrative penalties for minor

contravention with to the failure to comply with certain requirements of this Bill. Penalties raised shall as income to the Council. This is in line with similar legislation.

Regulations (Clause 6S)

Clause 68 makes provision for the Minister to make Regulations on matters such as minimum benefits, the level of solvency requirements, the criteria which should apply to administrators of medical schemes, specific measures that should be adopted to protect medical schemes from undue adverse selection, the interface between a medical scheme and managed health care entities and for conditions under which a medical scheme may provide benefits in terms of personal savings accounts.

This Chapter also includes a number of other issues such as exemption of the Council from payment of income tax; provisions on amalgamation of medical schemes; transfers; dissolution of a medical scheme, and on charges by suppliers of services.

14 Transitional Provisions (Clause 69)

Schedule 2 provides for the continued existence of the Council for six months, transfer of assets, liabilities, and transfer of employees of the State to the Council, the continuation of medical schemes that are currently registered under the Medical Schemes Act, 1967 (Act No. 72 of 1967), and for the registration of medical schemes

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established under the Legal Succession to the South African Transport Services Act, 1989 (Act No. 9 of the South African Police Services Act, 1995 (Act No, 68 of 1995) and the Correctional Services Act, 1959 (Act No. 8 of 1959) which currently are not registered under the provisions of the Medical Schemes Act, 1967.

15. Persons and bodies consulted:

Chartered Accountants Medical Aid Fund Concerned Medical Schemes Group Congress of South Trade Unions Council of Medical Schemes Department of Finance Life Offices Association

Hospital Association of South Africa Local Authorities Medical Aid Fund Medical Association of South Africa National Association of IPAS

National Congress of South African Trade Unions ProSano Medical Aid Scheme

Representative Association of Medical Schemes South African Chamber of Business

South African and Dental Practitioners South Health Care

Financial Services Board

16. Parliamentary procedure

The Department of Health and the State Law Advisers are of the opinion that this Bill must be dealt with in accordance with the procedure established by section 75 of the Constitution.

In document Análisis del aprendizaje histórico en estudiantes de segundo año en la preparatoria Emiliano Zapata: propuesta para promover la conciencia histórica (página 38-46)